Healthcare Provider Details

I. General information

NPI: 1649866021
Provider Name (Legal Business Name): REGAN DANIELLE OROURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 VENTURE CT # CY
COLUMBUS OH
43228-9600
US

IV. Provider business mailing address

4014 VENTURE CT
COLUMBUS OH
43228-9600
US

V. Phone/Fax

Practice location:
  • Phone: 614-297-8244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03338146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: